Bartonella bacilliformis

Background

Epidemiology

• Range is essentially restricted to the Andean mountains in Peru, Ecuador, and Colombia
• Transmitted by Lutzomyia sand flies
• Humans are primary reservoir

Clinical Presentation

• Traditionally presents as a biphasic illness with an acute phase (Oroya fever) and a late phase (verruga peruana)
• The acute phase starts after an incubation period of 3 to 12 weeks, and is characterized by fever, malaise, and a hemolytic anemia
  • May only last a week and not present for medical care
  • More severe disease can include high fever, chills, diaphoresis, anorexia, prostration, headache, and altered mental status
  • The anemia can be profound in severe disease
  • May be accompanied by severe myalgias and arthralgias, abdominal pain, emesis, jaundice, lymphadenopathy, thrombocytopenia, seizures, delirium, meningoencephalitis, obtundation, dyspnea, hepatic dysfunction, and angina, likely secondary to anemia and microvascular thrombosis
  • Severe disease has high mortality if untreated, but decreases to 10% if treated
• The late phase occurs weeks to months after the acute phase, and is characterized by disseminated nodular skin lesions
  • Crops of lesions proceed from miliary, to nodular, to mulaire lesions
  • Mulaire lesions are superficial vascular bulbous lesions that can bleed and ulcerate
  • Lesions can also be internal
  • Lesions can come and go, with recurrences, over weeks to months

Diagnosis

• During acute phase, may see intraerythrocytic bacteria on blood film